                                :short-answer "Yes – a child’s chances of survival can never be completely captured in a single formula. "
                                :glossary     [:risk-adjustment]
                                :body         [:div
-                                              [:p "Yes there are. Taking the different risks for each child into account in a formula (called 'risk adjustment') allows for fairer assessment of a hospital’s survival rate by putting into context (see also the " [:a {:href "?#/intro"} "What, why, how?"] " section),  but it still cannot make it completely fair. It is always ‘partial’ as there will always be information about important risk factors that are not routinely collected and so cannot be captured by risk adjustment methods (see also 2.3). Any statistical formula has to be developed on existing data and so the data will be typically at least a year out of date. So risk adjustment cannot adjust or account for future changes to the way data is collected (for instance more complete data) or new methods of surgical or medical management. Often, these statistical formulas are updated every few years with more up to date (in 2016, we updated PRAiS for the third time). "]]}
+                                              [:p "Yes there are. While taking into account the complexity of each child’s medical problems in a formula allows for fairer assessment of a hospital’s survival rate, it still cannot make it completely fair. There will always be information about important factors that affect a child’s chances of survival that are not routinely collected for national bodies and so cannot be captured by a formula that was developed using national data. "]
+                                              [:p "Any statistical formula has to be developed on existing data and so the data will be typically at least a year out of date. So risk adjustment cannot adjust or account for future changes to the way data is collected (for instance more complete data) or new methods of surgical or medical management. Often, these statistical formulas are updated every few years with more up to date (in 2016, we updated PRAiS for the third time). "]]}
+                                            
 
                               {:title        "How reliable are the data?"
                                :short-answer "The data are of very high quality and some of the best in the world."
                                :glossary     []
                                :body         [:div
-                                              [:p "The data come from the National Institute for Cardiovascular Outcomes Research (UCL NICOR) which collects national data for the National Heart Disease Audits. All hospitals performing heart surgery in children have to submit their data in a standard format to NICOR. All hospitals are independently audited each year as part of a data validation process (to check the quality of the data submitted)."]
-
-                                              [:p "So, the data are of high quality. While no large dataset is perfect (e.g., it is inevitable that a few records will not be 100% accurate), this dataset is among the most detailed and complete in the world for children’s heart surgery."]]
+                                              [:p "The data come from the National Institute for Cardiovascular Outcomes Research (NICOR) which collects national data for the UK National Heart Disease Audits. All hospitals in the UK and Ireland performing heart surgery in children have to submit their data in a standard format to NICOR. All hospitals are independently audited each year as part of a data validation process (to check the quality of the data submitted) to ensure that the data are of high quality."]
+
+                                              [:p "While no large dataset is perfect (it is inevitable that a few records will not be 100% accurate), this dataset is among the most detailed and complete in the world for children’s heart surgery."]]
                                }
 
                               {:title        "What are the limitations of the data?"
                                :short-answer "These data do not capture all the potential medical problems a child has and only represent a snapshot of survival outcomes. They cannot capture the full picture of the quality of care provided by a hospital."
                                :glossary     [:unforeseen-factors]
                                :body         [:div
-                                              [:p "Apart from occasional inaccuracies in the data, there are other limits to what the data can tell us about surgery outcomes. There are risk factors not routinely collected (for instance the size of a hole in the heart), which means these cannot be accounted for in our statistical formula. "]
-
-                                              [:p "These data are also snapshots in time of what happened at each specialist hospital. A number of particularly challenging patients one year (in ways not accounted for in our prediction) or a run of unforeseen factors could cause a very good hospital to have worse outcomes than predicted. So we need to be careful about reading too much into any single time period."]]
+                                              
+
+                                              [:p "Apart from occasional inaccuracies in the data, there are other limits to what the data can tell us about surgery outcomes. There are factors that affect a child’s chances of survival that are not routinely collected for national bodies and so cannot be captured by a formula that was developed using national data. These data are also snapshots in time of what happened at each hospital. A run of unforeseen factors could cause a very good hospital to have worse outcomes than predicted, so we need to be careful about reading too much into results from any single time period."]]
                                }
 
                               {:title        "What about longer term survival and quality of life?"
-                               :short-answer "At the moment these are not reported. There is active research underway to work how to report long term survival and quality of life for children after heart surgery but it will be some years before this becomes part of routine national audit."
+                               :short-answer "At the moment these are not reported. There is active research underway to work out how to report long term survival and quality of life for children after heart surgery but it will be some years before this becomes part of routine national audit."
                                :glossary     []
                                :body         [:div
-                                              [:p "National audit data at the moment (as of 2016) only looks at what happens shortly after surgery. These data cannot tell us about longer term (e.g. 90 day, 1 year or 5 year) survival, or other outcomes such as post-surgery complication rates or the impact of surgery on the child or their family. There is a lot of " [:a {:href "http://www.gosh.nhs.uk/medical-information/clinical-specialties/cardiothoracic-surgery-information-parents-and-visitors/research/complications-after-heart-surgery-children"} "active research"] " going right now (due to finish around 2018) investigating how to capture, interpret and publish longer term survival and complication rates so hopefully this information will be available in the next 5 years."]
+                                              [:p "Currently (as of 2016), National audit only monitors what happens shortly after surgery. These data cannot tell us about longer term (e.g. 5 year) survival, or other outcomes such as post-surgery complication rates or the impact of surgery on the child or their family. There is a lot of " [:a {:href "http://www.gosh.nhs.uk/medical-information/clinical-specialties/cardiothoracic-surgery-information-parents-and-visitors/research/complications-after-heart-surgery-children"} "active research"] " going right now (due to finish around 2018) investigating how to capture, interpret and publish longer term survival and complication rates so hopefully this information will be available in the next 5 years."]
 
                                               [:p "The data also can’t tell us about how or why a hospital achieved the recorded results, so it cannot, by itself, tell us whether one hospital offers better or worse quality care than any other. These data cannot tell you what the results are likely to be next year. It also cannot tell us anything about what happens to children who never get operated on for whatever reason, since data on these children is not currently submitted to national audit. "]]
                                }
 
-                              {:title        "Why is survival to 30 days used as the main survival measure?"
-                               :short-answer "Survival to 30 days is a more objective measure than survival to hospital discharge, since different types of hospital have different treatment pathways for very sick patients (for instance some will transfer patients to another hospital or some to local palliative care). "
+                              {:title        "Why is survival to 30 days after surgery used as the main survival measure?"
+                               :short-answer "Survival to 30 days after surgery is a more objective measure than survival to hospital discharge, since different types of hospital have different treatment pathways for very sick patients (for instance some will transfer patients to another hospital or some to local palliative care). "
                                :glossary     []
                                :body         [:div
-                                              [:p "Two very common measures used for looking at a hospital’s outcomes are “survival at discharge from hospital” and “30 day survival”. Survival at discharge is often used in other contexts as it’s the easiest to obtain – it is included within standard hospital records. However, survival to discharge does depend on the treatment and discharge pathways at that hospital. For instance, some hospitals will transfer very sick patients to other, more specialised hospitalised, meaning that more patients will be alive at discharge from that hospital than the specialised hospital. Some hospitals might have close links with local palliative care services and so might discharge patients to these services if further treatment is considered unavailing. Again, such hospitals with have more patients alive at discharge compared to a hospital that look after the sickest patients until they die. "]
-                                              [:p "Therefore, if it is available, “30 day survival” is considered a more objective and preferable statistic than “survival to hospital discharge”, since it does not depend on the hospital’s discharge pathways."]
-                                              [:p "While longer term survival is extremely important (see [link to longer term survival FAQ]), 30-day survival was initially chosen as it more straightforward to link this outcome to a child’s surgery and post-operative care than a longer range survival  period which might, for instance, incorporate further treatment at different hospitals. The other important aspect of monitoring 30-day survival, particularly within hospitals, is that any worrying outcomes can be investigated very quickly since the survival outcomes are available (locally) within 30 days of a child’s operation."]]}
+                                              [:p "Two very common measures used for looking at a hospital’s outcomes are “survival at discharge from hospital” and “30 day survival” after an operation. Survival at discharge is often used in other contexts as it’s the easiest to obtain – it is included within standard hospital records. However, survival to discharge does depend on the discharge procedures at that hospital. For instance, some hospitals will transfer very sick patients to other, more specialised hospitals, meaning that more patients will be alive at discharge from that hospital than the specialised hospital. Some hospitals might have close links with local palliative care services and so might discharge patients to these services if further treatment is considered unavailing. Again, such hospitals with have more patients alive at discharge compared to a hospital that look after the sickest patients until they die. "]
+                                              [:p "Therefore, if it is available, “30 day survival” after surgery is considered a more objective and preferable statistic than “survival to hospital discharge”, since it does not depend on the hospital’s discharge procedures."]
+                                              [:p "While longer term survival is extremely important (see [link to longer term survival FAQ]), 30-day survival post surgery was initially chosen as it is more straightforward to link this outcome to a child’s surgery and post-operative care than a longer range survival  period which might, for instance, incorporate further treatment at different hospitals. The other important aspect of monitoring 30-day survival, particularly within hospitals, is that any worrying outcomes can be investigated very quickly since the survival outcomes are available (locally) within 30 days of a child’s operation."]]}
                               ]
                     }
 

                                                                                                                                                                                                 :margin-right "20px"}
                                                                                                                                                                                         :src   "assets/bristol.png"}] "In the 1990s, problems were found with the standard of care for children having heart surgery at the Bristol Royal Infirmary. The proportion of children who died after surgery at Bristol was much higher than other UK hospitals. There was a formal inquiry into what happened (" [:a {:href "http://webarchive.nationalarchives.gov.uk/20090811143745/http:/www.bristol-inquiry.org.uk/final_report/the_report.pdf"} "The Bristol Inquiry 2001"] "), which led to a number of changes, including a new compulsory national reporting system so that the proportion of children surviving to 30 days after surgery for all hospitals have been published every year since 2001. Results where there is some evidence that survival rates are lower than expected are checked further by the hospital and the national audit body (NICOR)."]

                                              [:p "The UK now has one of the strongest monitoring programmes in the world. Since reporting started, " [:a {:href "http://www.bbc.co.uk/news/health-32162803"} "survival rates have been improving"] " and now " [:strong "over 97% of children survive to at least one month after surgery."]]]
                               }

                              {:title        "How are survival rates monitored?"

                    :faqs    [{:title    "Why do some children need heart surgery?"
                               :glossary []
                               :body     [:div
                                          [:p "About 6500 to 7500 babies are born with a heart defect (called congenital heart disease) in the UK and Ireland every year. Congenital heart disease covers a wide range of problems from the relatively minor (such as a small hole in the heart) to more severe conditions where a child needs specialist hospital care. About half of all children born with a heart defect will need heart surgery at some stage in their childhood. Children can also develop problems with their heart as they grow up which require hospital care (called acquired heart disease). "]
                                          [:p "Read more about "
                                           [:a {:href "http://www.chfed.org.uk/how-we-help/information-service/heart-conditions/"} "different heart conditions"]
                                           " and caring for children with heart conditions on the "
